The study from researchers at Hospital for Special Surgery (HSS) was reported at the American College of Rheumatology (ACR) Convergence 2022 meeting.
According to Cynthia, MD, MPH, an orthopedic surgeon at HSS and a coauthor of the study, TPA is rarely performed in patients under 21 years old but may be done in this population due to conditions such as inflammatory arthritis or juvenile idiopathic arthritis (JIM), malignant or non-malignant tumors, or trauma. However, the number of patients under the age of 21 undergoing TPA in the U.S. is unknown.
In one of the largest U.S. studies of an institutional arthroplasty registry, only 19 TPAs were performed in patients under the age of 21 out of approximately 30,000 primary TPAs over 34 years--a majority of which were for JIM.
The researchers retrospectively analyzed the Kids' Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years old in approximately 4,200 hospitals in 46 states.
The researchers used the International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TPA from 2000-2016 and determine the primary diagnosis.
Descriptive statistics such as means and percentages, along with their 95 per cent confidence intervals (95 per cent CI), were calculated using the appropriate sample weights as recommended by the Agency for Healthcare Research and Quality for use with the KID dataset.
The total weighted number of TPAs performed in patients younger than 21 from 2000-2016 was 1,331; the number of TPAs performed per year in this age group remained relatively stable. The mean age of patients undergoing TPA was 14.8 years (95 per cent CI, 14.4-15.2); 48.8 per cent of the cohort was female.
Among tumor patients, a higher proportion identified as Hispanic (22.1 per cent) or other race (12.6 per cent) compared to the non-tumor cohort; 70.3 per cent of TPAs performed for a primary diagnosis of a tumor, and the number of TPAs for malignant tumors increased slightly over the study period. In contrast, use of TPA for inflammatory arthritis / JIM decreased by more than 70 per cent over the study period, likely due to improvements in medical management of inflammatory arthritis / JIM patients.
The majority of TPAs were performed in urban teaching hospitals and in facilities with a large bed size, which likely reflects the complexity and rarity of these procedures.
"This was one of the first studies to take an in-depth look at TPA in this very young population," said, "Our study was able to confirm that tumors were the most common reason for knee arthroplasty in this population."
"I think the biggest takeaway as a rheumatologist is that we are doing a good job treating these patients and over the years the treatments for inflammatory arthritis are really working well in this young population," said Bella Meh ta, MBBS, MS, rheumatologist at HSS and senior study author. (ANI)
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